Tuberculosis Occurring During Steroid Therapy

Abstract

NEPHRECTOMY FOR HYPERTENSIONDelayed Cure Case 216 is classed as a failure though his blood pressure was reduced from 195/125 to 160/105 for one year, and he actually had some pre-operative readings of 190/140. The reason for this is the relatively short follow-up period. If he remains well at the present level for three years he might be reviewed later as a possible cure. This also applies to Cases 29 and 30. Case 14 is claimed under the 20% reduction as a success in view of vast clinical benefit maintained for four years; actually the diastolic pressure has continued to fall and is now 85 mm. Hg, and he could be regarded as a cure by any standards; a further justification of the 20% allowance. Case 218 is a late failure after eight years' relief. Case 16 is the only one that would not justify the 20% reduction, for though the diastolic pressure fell from 140 to 110 mm. Hg for three years, it then relapsed to 130 mm. Hg. He is therefore classified as a failure.The 20% reduction in diastolic pressure seems to be justified as an additional claim for cure if there is marked clinical benefit and the follow-up is extended for three years. Also it would be better if "good result" or "good effect" were claimed rather than " cure."9 Summary and ConclusionThe literature on the subject of nephrectomy for hypertension is discussed and reasons for a more optimistic approach to this problem are advanced.Agreement is noted on the investigations required.Eighty-nine personal cases of nephrectomy for unilateral renal disease in hypertension are reviewed and 66 accepted for analysis.Criteria for a claim of success are discussed and a new standard is suggested.The 66 nephrectomies have been analysed and a 45.5% cure is claimed, for which a diastolic pressure of 90 mm. Hg for one year is required. In addition, a few patients symptomatically cured for three years with a 20% fall in the diastolic pressure (even if remaining above 90 mm. Hg) are included.If the additional claim of those with a 20% fall in diastolic pressure is rejected, the claim for cure is 37.9%.The younger the patient the better the result.Patients over 50 seldom benefit unless the hypertension is recent.While every patient must be considered and assessed as an individual problem it is hoped that a more optimistic approach may be made to these cases.Certainly hypertension in young people must be investigated for a renal cause, and early nephrectomy of a suspected kidney will offer these patients a 50% chance of cure. The number of patients who have been adversely affected by such treatment must be very small; I have not encountered any.It is recommended that a diastolic pressure of 90 mm. Hg be required for one year to claim a good result, but that patients who have been symptomatically cured for three years with a 20% fall in the diastolic pressure should also be included as good results.I thank Mr. P. Holmes, Mr. C. Q. Henriques, Miss Gadsby, oand Miss Henriksen for help in tracing the follow-up of cases.